



\ 



SF 258 
.S2 M5 
Copy 1 



Tke Milk Problem m St. Louis 



PREPARED BY 



Elizabeth Moore 

AND 

Minnie D. Weiss 



UNDER THE DIRECTION OF 



George B. Mangold, ph. d. 



DEPARTMENT OF RESEARCH 



ST. LOUIS SCHOOL OF SOCIAL ECONOMY. 



The St. Louis 
School of Social Economy 

A Training School for Social Workers 
Affiliated with Washington University 

Special Day and Evening Courses 
Certificate Course. 
Master of Arts Course. 
Supervised Practice Work. 
Attractive Fellowships, 

LOW TUITION. 



THOMAS J. RILEY. DIRECTOR 

GEORGE B. MANGOLD. ASSOCIATE DIRECTOR 
Department of research 

(RUSSELL Sage foundation) 

LUCY OPPEN, Assistant and Adviser of Women 

DEPARTMENT OF PRACTICE 



For Information address 

THE DIRECTOR, 

The School of Social Economy. 

19th and Locust Streets. 

ST. LOUIS. MO. 



% HF D. 









CONTENTS. 

Chapter I. — Origin and History of tlie Milk Snpplv of 

St. Louis :; 

Cliapter 11. — Condition of the Summer Milk Supply in 

St. T.ouis 13 

Chapter III. — Relation of Milk tn I'.ahies J2 

Chai)ter W . — Milk Regulation in ( )ilier t'ities 30 

Recommendations 3^^ 



INTRODUCTION. 

The St. Louis School of Social Economy has made an extensive 
study of the cause of infant mortality and sickness in St. Louis. The 
study included an investigation of all deaths in the second, third and 
fourth sanitary districts, of children under five years of age for an 
entire year. A special study was also made of sickness among small 
children during the summer months, and an additional inquiry was 
directed into the character of the summer milk supply. In view of 
the large factor which our investigation shows poor milk to be as a 
cause of sickness and mortality, this report is offered to the public 
with the hope that the needed reforms may be accomplished. 

The School of Social Economy wishes to express its thanks to 
the St. Louis Pure Milk Commission and the Missouri Botanical 
Garden for the generous provision of laboratory facilities for the 
work embodied in this bulletin ; and to the officials of the Health 
Department and the officers of many dairy companies for assistance 
in getting much of the information contained therein. 



CHAPTER I. 

ORIGIN AXD HISTORY OF THE MILK SUPPLY OF 
ST. LOUIS. 

Like all large cities, St. Louis draws its milk from a large dis- 
trict, surrounding and including the city. By far the most important 
part of this district, from a milk-production standpoint, is that in 
western Illinois, a zone with numerous dairy centers, extending 
roughly between 20 and 100 miles from the city. In eastern Mis- 
souri dairying" is not so important a business, and there are only 
a few centers, with a fair number of scattered dairy farms. Then 
also there are dairies in and immediately surrounding the city. The 
conditions of milk production in all these dairies, together with the 
methods of transporting and handling the milk, both in the country 
and in the city, are the factors determining whether the milk, which 
supplies such a vital need of the city, is good or bad, wholesome or 
unsafe. As far as is possible in a brief account, the more important 
of these features, from a sanitary standpoint, are discussed in this 
chapter. 

CIT^ Dairies. 

It is estimated that about one-fourth of the milk sold in St. 
Louis is produced within the city. Approximately 5,000 cows are 
kept here, in 175 dairies having from 4 to 150 cows each. Most of 
these cows stand in the stable month in and month out, many of them 
without even a chance to move about in a barn-yard ; and this con- 
finement is so hard on them that they can be kept only one season. 
So it is emphatically a question whether the cows can give whole- 
some milk while living so unhealthy a life. In addition, many of 
these dairies feed "brewers' slop ;" and it is plain that this affects 
the C|ualit^■ of the milk, for the milk and even the cream from such 
a dairv is a ghastly, chalky white that dift'erentiates it instantly from 
country milk. 

The cows in the "city" dairies are not tuberculin-tested. Pos- 
sibh' the}' do come into the city comparatively free from tubercu- 
losis, as is claimed ; but since that disease is one of the reasons why 
cows cannot be ke}bt for any length of time in these places, it does 
not seem likely that they all remain free from it during the time 
that they are contributing to our milk supply. Wlienever a cow 
has tuberculosis, there is real danger of the tuberculosis germs 
(tubercle bacilli ) getting into the milk, and then an ever-present pos- 



sibility of their doing serious damage. And in the case of the "city" 
dairy, the milk is almost all sold raw. 

On the other hand, these dairies are under the supervision of 
the Health Department, and most of them are kept decently clean. 
The stables are required to have sound floors and white-washed 
walls and ceilings ; the cows must be kept clean ; the milk-room and 
all the apparatus must be in decent condition ; and the milk must be 
promptly cooled with ice. These are not the only necessary pre- 
cautions for sanitary milk production ; but it is something — in truth, 
a good deal — to be assured of even so much. Moreover, the milk 
from these city dairies gets to the consumer rather promptly, for it 
is nearly all peddled out by the producer; and as we shall see, this 
is no inconsiderable advantage. This ''city" milk is mostly cheap 
milk sold from the can ; and last summer it was found to contain far 
less bacteria than other "loose" milk. This is undoubtedly due to 
its greater freshness. 

So there is something to be said on both sides of the question, 
whether the "city" milk is comparatively good or bad milk. But 
in any case, it is a diminishing factor of the whole milk problem ; 
for both the number of "city" dairies and the number of cows 
therein diminish year by year. Dairymen go out of business for 
one reason or another ; and no new cow-stables are allowed to be 
built. Dairying within the city was at one time the main source 
of supply for the city ; and the dairies which remain are hardly 
more than a remnant of an obsolete method of handling the business. 

Dairies Outside the City. 

Meantime, what of the milk which comes from outside the city ? 
In the first place, there is a small amount of milk which is brought 
in by wagon from the surrounding country, and often delivered 
by the producer. Some of these county dairies are of the best class, 
producing milk selling at 15 or 20 cents a quart. Others are of the 
lowest order, belonging to the most backward and obdurate of the 
city dairymen, who have moved beyond the city Hmits in order to 
get away from the supervision of the Health Department. (Then 
they can sell as dirty milk as they please.) And of course there 
are other "just ordinary" country dairies in this group. 

But the vast bulk of all our milk — the dominating factor in the 
situation— is the "shipped" milk: i. e., that which comes into the 
city by railroad. Where does it come from? From what sort of 
places? What happens to it, both on its way into the city, and after 
it arrives? 

The "shipped" milk — some thirty thousand gallons a day — 
comes from 4,500 or 5,000 farms, scattered over eastern Missouri and 
western Illinois, but most of them located in the dairy zone in Illi- 
nois, which furnishes from three-fourths to four-fifths of this sup- 
ply. Now, to a large extent the character of our milk is determined 
on these farms ; for dirty milk on the farm can not become clean 
milk, nor bad milk good, although the reverse may all-too-easily hap- 
pen. What do we know about them ? In the first place, that they are 



subject to practically no sanitary inspection, so that the milk is at 
the mercy of the standards of cleanliness of each individual farmer. 
The inspection officials of the states of Illinois and Missouri are 
without real authority over sanitation ; and so far, St. Louis has 
done nothing to protect itself. The dairy companies as a rule will 
accept pretty nearly any milk that does not smell sour when it 
arrives ; and' there is plenty of opportunity to pass unwholesome 
milk through those limits, for milk may be pretty bad from a sani- 
tary standpoint long before it sours or even smells bad. 

Condition of the Dairy Farms. 

During this investigation, 64 farms selected at random in eleven 
districts in Illinois and Missouri were visited. 

Some distinctly insanitary conditions were found to be very 
common, if not prevalent. For instance, over half of the cow- 
stables inspected had dirt floors, most of them without any gutter 
or drainage arrangements ; it is inevitable that such a floor is more 
or less impregnated with manure, and it easily degenerates into an 
impossible condition when not well cared for, especially in wet 
weather. Tight floors — wood or cement — are required practically 
everywhere that there is any sanitary supervision. That cement 
floors are not beyond the reach of the farmers of this region is 
shown by the considerable number who do have them. Then, a 
large proportion of the barns have no windows at all, while only 
one-fourth were found to have as much as one square foot of win- 
dow-space per cow. The official U. S. standard is four square feet. 
Dusty ceilings are very much in evidence; what is surprising is that 
no farmer was found who took the simple precaution of whitewash- 
ing the inside of his stable, and only a very few who even swept the 
cow-webs down from their ceilings — generally the only clean ceil- 
ings were the new ones. On nearly half the farms, horses and 
cows were stabled along side of each other or at best on opposite 
sides of the passage way, which is not a good thing in a milking- 
barn. The cows keep pretty clean as long as they are out on pas- 
ture ; but in the winter dirty cows are so much the general rule that 
a farmer who cleans his cows is a shining exception. On the only 
inspection trip made in wet weather, every barn-yard was found 
knee-deep in mud ; of course that is hard to remedy, but it is sure 
eventuallv to transfer altogether too much of that mud by way of 
the cows into the milk. A'ery commonly during the winter the 
manure is pitched out of the windows and piled up against the barn, 
or at best a few feet away in the yard ; that adds to the cleanliness 
neither of the barn nor of the barn-yard. 

Throughout this investigation, the only farmers who were found 
to have had their c'ovvs tuberculin-tested were an occasional owner 
of a pure-bred herd. It is impossible without the use of the test to 
tell anvthing about how much tuberculosis there is among the cattle, 
for it is onlv advanced cases that make themselves evident. Un- 
doubtedlv. there is a good deal of it : it has been estimated that 10 







Jiitx'i^ 



per cent of the dairy-cattle in Missouri are infected, and where 
dairying has been long established without protection through, test- 
ing, as in Illinois, the disease of tuberculosis, which tends to spread, 
is very likely to be still more prevalent. 

As to methods of handling the milk — aside from the impossi- 
bility of getting clean milk from a dirty cow in the dusty barn — the 
first general criticism to be made is that the practice of filling the 
milk-cans inside the stable is much too common. Secondly, it has 
been proved in many places that the use of small-mouthed milking 
pails is one of the most practicable and effective methods of diminish- 
ing the amount of dirt which falls into the milk, especially in dusty 
surroundings ; but no such pails were seen. Finally, the cooling of 
the milk on the farm is distinctly ineffective ; it is the custom to cool 
the milk by setting a large S-gallon can in a tub or tank of well- 
water, but this will cool the milk neither quickly enough nor cold 
enough to make it really fit to be shipped to the city. When we find 
the Boston authorities insisting on "'a liberal use of ice" by the 
farmer, even in the cooler New England climate, we must realize 
that we have an unfortunate situation to face, in that we draw milk 
from a country where there is no ice on the farms. 

This state' of things could be improved by an authoritative in- 
spection service. Doubtless the improvement would be rather slow, 
and naturally sbme bad conditions would be more difficult 
to remedy than others : but eventually a great deal of good could be 
accomplished. 

There are other conditions, worse but not so general, which were 
found in occasional distinctly "bad" dairies; for example, a stable 
floor which in dry weather was a trampled mass of filthy mud. a 
wooden floor hidden under accumulated manure or a cement floor 
that w^as a pool of filth, stables where hay and cob-webs can sift their 
dust into the milk, unimpeded by any ceiling, cows whose .sides and 
udders were caked with manure ( apparentl_\- "for the winter"), milk- 
buckets left on the dusty floor of a dirty barn, or cans left unwashed 
until afternoon or even the next day and then washed with cold 
water at the barn well. Such things are not the rule, but they are 
actual cases ; and the milk from such farms is mixed with that from 
better ones, contaminating it all. For in handling milk, "the chain 
is no stronger than its "weakest link." Because there are better 
farms is no reason for tolerating the bad ones; on the contrary, it 
only shows that the notably bad ones are inexcusable. It is here 
that inspection would be most immediately effective, in eliminating 
such conditions and practices; and evidently we can trust only to 
official inspection to ])erform this service for us. 

Collecting Stations. 

Some of the I'nilk from the farms is shipped directly by the 
farmer to a distributing dairy in the city. About three-fifths of the 
milk sent to the citv (and most of the cream), however, first passes 
through the hands of a collecting, station or "creamery" at the near- 
est railroad staf'cm. which buys "the milk from the farmer and as- 




on 



a 



V) 



tf) 



snmes all further responsibility for its progrc>> toward the city. The 
milk is gathered from the farmers in several ways. The farmer 
after the milking- in the morning may haul his milk directly to the 
creamery. Sometimes several farmers join in the establishment of 
a route and the men take turns in hauling the milk of the co-opera- 
tors. More frequently one farmer on a route is paid by the others 
for hauling the milk. Whichever method of collecting is used, the 
milk is not under refrigeration while on the way to the creamery. 
Frequently the hot sun beats down on the milk cans and hastens the 
spoiling of the milk. 

Half of these creameries, including the largest ones, are owned 
and operated by the large dairy companies in the city ; from the 
others the milk is bought by contract. At this point the history of 
the milk differs. Some of the dairy companies, and some of the in- 
dependent creameries, have their milk pasteurized''' at the creamery 
before it is sent into the city ; other creameries rely upon thorough 
cooling to keep the milk in good condition, or pasteurize it only dur- 
ing" hot weather. 

Two distinct objects are sought by pasteurization. From the 
sanitary standpoint, it is a means of destroying the disease-producing 
germs in the milk ; and to be reliable for that purpose, it must be 
thoroughly done, under the supervision of someone who understands 
the process. From the point of view of the average dairy -man. it 
is a means of reducing the miscellaneous bacteria in the milk and 
therebv making it keep longer. Unfortunately a less efficient pas- 
teurization seems to serve fairly well for this purpose ; unfortunately 
also, the dairy-man may and all too often does use the process as 
a substitute for carefulness in keeping the milk free from bacteria, 
or as a makeshift to enable him to keep the milk longer than it 
ought to be kept. In other words pasteurization delays the souring 
which is nature's danger-signal of stale milk. Nearly all the 
"shipped" milk in St. Louis is pasteurized. The milk which is pas- 
teurized at the creamery, is again pasteurized after reaching the city : 
and to this "double pasteurization" practice there are serious objec- 
tions. It is not because the repeated heating injures the milk chem- 
ically — it probably does not — but rather because, when the same 
milk is pasteurized twice, it means in plain language that that milk 
has been allowed to get well on toward the spoiling point TWICE — 
that it is raising its third crop of bacteria when it reaches the con- 
sumer and is loaded down with the remains of the two previous 
crops. If repasteurization were prohibited, arrangements would 
have to be made to deliver fresher milk. 

In any case, whether pasteurized or not (but more commonly 
when pasteurized), much of the milk remains at the creamery until 



*Note: Pasteurization is the trade name for the process of heating 
milk to a temperature considerably below the boiling-point, 140 degrees 
to 160 degrees^ in order to kill the bacteria which it contains. The com- 
mercial process consists in running the milk through a heaiing machine 
made for the purpose, of which there are several t.vpes, and then cooling 
it, which is equally important. 

9 



the second day. At stations where the milk-train leaves early in 
the morning, this can hardly be avoided ; but in some cases the train 
does not go until 8 or 9 or even 10 o'clock, and still from one-third 
to two-thirds of the milk from that station will not be ready for it, 
but must wait until the next day. Where the milk is pasteurized, 
the delay is made almost inevitable by the time which that process 
requires ; but in some instances it is due merely to a lack of insist- 
ence on prompt delivery from the farmers. In other cases a pos- 
sible afternoon train is not utilized because it would be "incon- 
venient" to the dealer to receive milk late in the day. 

All the creameries have means of cooling their milk — ice, or 
refrigerating machines — and have refrigerator rooms or iced storage 
tanks for holding it when necessary. This cooling is generally 
efficient, often bringing the temperature of the milk down to 40 
degrees. And the milk seems very generally to be handled in a 
cleanly manner, though of course some of the creameries are much 
better built and equipped than others. One weak point in the sys- 
tem is, that in many places the water supply is taken from a shallow 
well, located typically along side of the building, or in or near the 
railroad ditch, and either uncovered or exposed to surface drainage. 
Some creameries provide facilities for the farmers to wash and 
steam their cans, and a few require it to be done ; it would be well 
if this were the case everywhere, as cans so cleaned are in much 
better condition than those left unwashed for some time after empty- 
ing and then washed without steaming. 

Tr.\nsportation. 

While milk is being trans]jorted to the city, it is subjected to 
most unfavorable conditions. For, incredible as it may seem, there 
is no cooling or icing of the milk on the cars in transit, even in 
summer-time, (lur milk comes to us from 50 to 100 miles away 
on slow local trains, requiring a journey of two or even three hours, 
sometimes in the heat of the day, with no protection from the sum- 
mer sun except the roof of the car. This is bad enough for the milk 
which starts from a creamery storage room at 40 degrees, but it is 
even worse for the milk coming directly from the farmer's well- 
tank at a temperature not below 55 degrees or 60 degrees. Indeed 
it is a wonder that any of the direct shipments arrive sweet in the 
summer. This is a condition which would not be tolerated in any 
other first-class city ; and it would undoubtedly be remedied promptly 
enough if our ordinance requiring milk to be kept cold (below^ 50 
degrees) could be enforced, as in Xew York, by the confiscation 
and destruction of all milk arriving too warm. 

DiSTRIRUTION. 

After the milk reaches the city, it passes for distribution into 
the hands of some one of the forty-odd dealers in "shipped" milk. 
Fully half of these are men who receive and store a few cans of 
milk from a few farmers, and retail it in their immediate neighbor- 

10 



hood, possibly bottling some of it. Such dealers make their business 
very much of a "family afTair." l)eing assisted by members of the 
family in washing, bottling and selling, and carrying on these opera- 
tions close to the living-rooms. Hence it seems likelx' that, in com- 
mon with the "city" milk handled in similar establishments, this milk 
is rather more liable to disease-contamination than that of the larger 
plants which is handled in a wholesale way. b}' machine. 

City Milk Plants. 

The larger dealers in "shipped" milk all pasteurize their output, 
in the city. As a general thing, the milk which they receive one 
morning is pasteurized (and bottled so far as that is done) that 
day and delivered to the customers the following morning. Thus, 
that part of the supply which, coming through the creameries, has 
been already held in the country over one night, is in at least its 
third day — 48 to 60 hours old — when it reaches us ; and in the 
winter, when conditions of temperature are better, there is a good 
chance of its being 24 hours older still, because then many farmers 
deliver their milk to the creamery only every other day. The milk 
shipped directly from the farmer is not so old ; but on the other 
hand it is not so thoroughly cooled before coming to the city. 

The plants where the pasteurized milk is handled are of all de- 
grees of excellence, and the reverse. A number are located in 
unfortunately close proximity to their own stables. There are indi- 
cations that in one or two places the incoming milk is tested by the 
man in charge sticking his finger into each can and licking the milk 
off. There is one plant — not a small one either — where the bottles 
are washed out in the driveway, and the pasteurizer, a dilapidated 
machine with rusty pipes, most inefficiently operated, is located in 
a dark, damp, dirty cellar, opening on the sidewalk, and with the 
ceiling encrusted with dirt directly above the open milk-tank. On 
the other hand, there are milk-plants which are almost models, and 
in which the milk is treated with scrupulous care. 

Certainly if the consumers would adopt the habit of visiting the 
depots from which their milk comes, such a place as the one de- 
scribed above which bears its defects so plainly upon its face 
would be put out of business. But meantime, such conditions, and 
others not so obvious, ought not to be allowed ; and the Health De- 
partment (which is fully aware of their iniquity) should be given 
the necessary authority to end them. At present about all that 
the Sanitary Division officers can do with an insanitary milk-plant 
is to adopt a policy of constant nagging : and although within a year 
they have had the satisfaction of seeing one of the worst in the city 
finally torn down and rebuilt, still they ought to be enabled to take 
more peremptory measures. 

■ Then too. pasteurization is a process which requires careful and 
expert management, to avoid the pit-falls lurking in insufficient 
heating, insufficient cooling, and contamination after pasteurization ; 
and it is only to be expected that the smaller plants especially lack 
trained managers and foremen (but any foreman may become care- 

11 



less or unduly economical) and need supervision. For instance ni 
one of the smaller plants, in most respects a first-class place, the 
pasteurization consisted of momentarily heating the milk to 150-152 
degrees, and of then cooling it to about 60 degrees — both steps thor- 
oughly inefficient for destroying and preventing the growth of 
bacteria. If we are to have "pasteurized milk" upon whose whole- 
someness we can in any way depend, we shall have to provide official 
supervision of the process. Otherwise "the last state of the milk 
will be worse than the first." 

Each year, a constantly increasing proportion of all our milk 
is bottled ; and the best dairies bottle all their retail milk. This is 
undoubtedly an excellent thing ; for bottled milk is almost invariably 
found to be in much better condition than "loose" milk from the 
same plant. But — to what extent are we protected against infected 
bottles, for instance from a case of consumption? There is no gen- 
eral enforcement of sterilization, and it is pretty safe to say that 
where the bottles are not steamed at all — and in many plants they 
are only washed by hand — they are dangerous. This is one of the 
important matters which must be strictly looked after, if bottling is 
to be the safeguard which it should be. 

Of course all these statements must not be taken to apply 
universally to all of our milk, or to all of the companies or individ- 
uals who handle it on its way to us. Some are liable to very little 
criticism : and many are doing the best which they see, to provide 
good milk — a hard problem at best. But the evils spoken of do 
exist, and are not isolated instances. And iti planning to improve 
the situation, we must keep in mind the bad conditions, which are 
the ones that need reforming. If any dairy conducts its business 
according to high standards, surely that dairy will be the last one to 
object to the elimination of practices of which it would not be guilty. 

To recapitulate : It appears from this investigation that the 
cliief evils from which the bulk of our milk-supply suffers are — 

( i) I'ninspected. and hence in m,any instances insanitary, dairy- 
farms. 

(2) Too great delay in delivery to the consumer. 

(3) Lack of cooling on the trains. 

(4) Unregulated pasteurization. 

(5) In some cases, insanitary distributing plants. 



12 



CHAPTER II. 

CONDITION OF THE SUMMER MILK SUPPLY 
IN ST. LOUIS. 

During the summer of 1910. a number of samples of milk from 
thirty different dairies were examined, in order to ascertain the con- 
dition and quality of our milk as we get it in the summer. As far 
as possible milk was selected which was being used for sick babies, 
because it is to them that the condition of the milk is most vitally 
important. The samples included all sorts and conditions of milk, 
from all sorts of sources — from both the large and the small dairies, 
both "city" and "shipped"- milk, both "loose" and bottled milk, both 
raw and pasteurized milk. Some of them were bought from Ihe 
dairies themselves or from their wagons, others from stores, and 
still others from the homes of customers. 

Chemical Composition of the Milk. 

The first question which was investigated related to the chemical 
composition of the milk : ( i ) whether the milk had been adulterated 
by the addition of artificial coloring, or preservatives; (2) whether 
it had been skimmed; (3) whether it had been watered — in other 
words, whether the customers were cheated out of the amount of 
nourishment which ought to be contained in their milk. All these 
points are covered by the provisions of our present milk ordinance, 
which are effectively enforced by the staff of the City Chemist's 
office as far as its numbers permit ; but it is obvious that two in- 
spectors taking samples cannot fully control all the milk sold in a 
city of the size of St. Louis, from 3,000 stores and 500 wagons. 
The officials are continually finding violations ; and it is not surpris- 
ing that the School of Social Economy did also. 

( 1 ) We found artificial coloring once, and formaldehyde once. 
Formaldehyde is by far tlie most commonly used milk-preservative, 
so no tests were made for other preservatives. Last summer for- 
maldehyde was repeatedly found by the Department of Health in 
the milk of one dairy — the same one in whose milk we found it; 
but in general it appears that the practice of using preservatives is 
largely stamped out. 

(2) The St. Louis ordinance requires that milk which is sold 
as whole milk shall contain at least 3 per cent of butter-fat. This is 
rather a low standard. The requirement in a number of cities is 
3.S per cent; the dairy companies themselves object to taking milk 

13 



from the farmers which contains less than 3.5 per cent: and the 
Missouri State Standard is 3.25 per cent. In case the butter-fat in 
a mixed lot of milk from different herds falls below 3 per cent, it 
is a good sign that some of the cream has been removed. We 
found that practically all the bottled milk samples contained 
over 3 per cent of fat, and nearly two-thirds of them, 3.5 per cent 
or more. But among the "loose" milk samples, only one-sixth were 
above the standard ; and one-third were below even 2 per cent. 
This means that nearly all the "loose" milk is partially skimmed, 
containing about as much fat as ordinary hand-skimmed milk. This 
would be no fraud if the customers knew what they were buying, but 
we were never told that it was skim-milk, so presumably other cus- 
tomers are likewise left in ignorance. It is difficult to do anything 
with such cases, because the seller will invariably tell an inspector 
and the court that he was selling skim-milk. There is a municipal 
ordinance requiring the display of skim-milk signs where skim-milk 
is sold, but it has been held up for the present by an adverse decision 
as to its legality. 

During the four months, June to September, 1910, out of the 
samples taken by the City Chemist's inspectors, and declared to be 
whole milk, 38 per cent of the store milk and 3 per cent of the 
wagon milk contained less than 3 per cent of fat. It is impossible 
to judge how much of these two classes was bottled milk. The 
most obvious inference is that the wagon-drivers knew enough to 
declare their skimmed milk as such, while many of the store-keepers 
did not. The figures are practically the same for the eight months, 
April to November ; since November there has been sufficient im- 
provement in the store milk to bring its proportion of milk below the 
required standard for eleven months down to 25 per cent. 

(3) In the same way that skimming is detected by a decrease 
in the percentage of fat in the milk, watering is indicated by a de- 
crease in the percentage of the other solid constituents of the milk, 
called "solids-not-fat." The legal requirement for these is 8.50 per 
cent — again a fairly low standard, for the average of normal milk 
is estimated to be about 9 per cent. A reduction of the solids-not- 
fat from 8.5 per cent to 8.25 per cent indicates the addition of 3 per 
cent of water ; and to 8 per cent, the addition of 6 per cent of water. 
The percentages in our samples were as follows : 



Solids 
Nqt Fat. 


Interpbetatiok. 


Bottled Milk. 
34 Samples. 


Loose Milk. 
31 Samples, 


8.5% and over. 


Not watered. 


29% 


32% 


8.5% to 8.25% 


suspicious. 


38% 


23% 


under 8.25% 


watered. 


32% 


45% 


under 8% 


much watered. 


18% 


35% 



Thus it appears that although about the same proportion of both 
classes — approximately one-third — was all that was above suspicion 
as to watering, when we come to the samples that were belozv sus- 
picion — i. e. pretty certainly watered — the bottled milk shows up 
decidedly better than the "loose" milk — 32 per cent against 45 per 



14 



cent. And when we come to the figures indicating a considerable 
amount — 6 per cent or more — of watering the "loose" milk shows 
twice as many cases. Indeed it is even worse than that, for the 
watering of the loose milk is sometimes truly flagrant; we found 
four samples which contained less than 6 per cent of solids-not-fat, 
or 30 per cent of added water. 

This is a decidedly bad showing. It demonstrates that, aside 
from sanitary considerations, a quart of "loose" milk for five cents 
is not so good a bargain in comparison with bottled milk at seven 
cents, as affpears on the surface, since the former is probably 
skimmed and very likely watered. In other words, the purchaser of 
a quart of loose milk gets less nourishment — really less milk — than 
if he had bought bottled milk. 

Among all the City Chemist's samples of milk, both whole milk 
and skim milk, for the four months — June to September — 62 per 
cent of the store milk and 17 per cent of the wagon milk — or 22 
per cent of all — contained less than 8.5 per cent of solids-not-fat. 
Some of these, of course, fell only a little below the standard, and 
are hardly to be called watered. The figure for the store milk cor- 
responds very closely with what we found in the "loose" milk — 68 
per cent. There was some improvement in the average for the eight 
months, April-November ; and considerable improvement since then, 
so that the corresponding figures for eleven months are T^y per cent 
and 14 per cent. This undoubtedly shows a real and substantial 
decrease in the amount of watering of the store milk. 

Who did this watering, is a difficult question to answer since 
the milk passes through so many hands. There is some indication 
that at least part of it originated back on the farm. But in any 
event, the person who sells the milk to the consumer is legally re- 
sponsible 'for the quality of the milk. 

Temperature. 

In investigating- the sanitary condition of the milk, there are 
many things which cannot be told satisfactorily from any examina- 
tion of samples, but only by following its history carefully from the 
time it leaves the cow until it reaches the consumer — and after. But 
there is at least one important factor in the care of the milk, which 
we can easily check up. This is the temperature at which it is kept. 
All authorities agree that milk (and most especially milk for the 
supply of a large city, which has to make a long and devious journey 
before it reaches the consumer) MUST BE KEPT COLD in order 
to keep it in even decent condition. And cold in this connection 
means below 50 degrees. Accordingly St. Louis, like most other 
cities, has a requirement that milk shall be "maintained until deliv- 
ered to consumer at^or below 50 degrees F." There are no figures 
available as to the temperature of the milk when it arrives in the 
city — undoubtedly it is generally too high in v.'ami weather, as ex- 
plained in the previous chapter — but our experience indicates that 
even after arrival and probable cooling at the dairy, the proper 
temperature is seldom maintained. 

15 



The following table shows the temperature at which our various 
purchases of milk were sold to us : 



TEMPERATI'KE. 



Bottled Milk. Loose Milk. Total. 

25 Samples. 81 Samples. 56 Samples. 



50 degrees or under. . . . 367^ ' lo^r 21% 

50 to 60 degrees 529; 55% 54% 

60 degrees or over \2.% 35 '/r 25% 

Over 50 degrees 64 9^^ 907^ 79% 

That is, nearly four-fifths of all samples — and 90* per cent of 
the "loose" milk — were above the legal temperature when sold, and 
one-fourth were 10 degrees or more above the standard. This is one 
point which is already covered by the necessary ordinances; and if 
it could really be enforced, not only by fines., but also by destruction 
of warm milk, it would improve our milk supply more than any 
other equally simple step that could l^e taken. 

B.\CTERiA IN Milk. 

The best available criterion of the general sanitary condition of 
a sample of milk is the number of bacteria (expressed as the num- 
ber per *cubic centimeter) which it contains. This is true for two 
reasons: first, because it has been found in practice that the whole- 
someness of milk, especially for babies, depends very largely upon 
its freedom from bacteria ; and second, because the various in- 
sanitary influences which may injuriously affect the milk^dirt from 
dust, manure, or contaminated utensils, or lack of prompt and ef- 
ficient cooling, or too-long holding, or any carelessness in handling 
— are invariably followed by an increase in the number of bacteria. 
Hence when an unusually large number of bacteria are found, it is 
a sure sign that something has gone wrong. We cannot tell what 
that "something" was, except in the most general way ; that is, we 
can make a rough inference as to whether the trouble is due to stale- 
ness or keeping too warm, or to excessive dirt-contamination. But 
in any case, the milk is deteriorated, so that the distinction as to 
cause is not of very great practical importance. 

The vast majority of the bacteria commonly found in milk are 
non-pathogenic ; that is, they do not produce any particular disease. 
When the bacteria or contagion of specific diseases, as tuberculosis, 
typhoid-fever, diphtheria, or scarlet-fever, do get into the milk, they 
give rise to the most acute dangers which we have to meet in the 
milk supply, and also one of the most difficult to guard against. 
Fortunately such infection of the milk (except that with tubercu- 
losis) is not a common occurrence ; and the pathogenic bacteria can 
almost certainly be destroyed by thoroughly heating the milk. It is 
true that the presence or absence of large numbers of miscellaneous 
bacteria in milk does not prove the presence or absence of specific 
pathogenic species. Nevertheless the chances for disease-contami- 



*Note: One cubic centimeter equals one-half teaspoouful: or a glass 
contains about 200 c. c. 

16. 



nation are greatest where milk is carelessly handled in any way ; 
and this is exactly the condition which is betrayed by a high bacterial 
count. Hence such milk must be regarded with suspicion. ]\Iore- 
over, experience has shown that it is actually unwholesome in the 
sense of being apt to cause digestive disturbances. 

Occasionally someone maintains that the bacteria in milk are 
of no importance to health because they are all the acid-producing 
bacteria, which are not themselves harmful. But this is not so. 
\'ery seldom, except in milk which is sour or getting ready to sour, 
are the acid-producing bacteria in even a large majority; in 
over half of our samples we found that these bacteria were less than 
a majority. The rest are miscellaneous bacteria generally originat- 
ing from dirt of some kind ; some of them are putrefactive bacteria, 
which tend to decompose or "rot" the milk, giving rise to unpleasant 
tastes and odors, and making it peculiarly unwholesome. 

The numbers of bacteria found in milk are always astounding 
to anyone who is not accustomed to them, being for instance out of 
all comparison greater than those found in the very worst water. 
This teeming bacterial life results both from the circumstance that 
it is very difificult to avoid getting dirt — and the "dirtiest" kind of 
dirt — into the milk at milking time, and also and especially from 
the fact that milk is one of the best known foods for bacteria, in 
which they will grow vigorously and multiply enormously, if given 
half a chance. This is why it is so extremely important to keep 
milk cold. The very highest grade of milk, produced and cared for 
with the greatest precautions, does well if it shows less than lo.ooo 
bacteria per c. c. by the time it is 24 hours old. In St. Louis the 
requirement for Certified ]\Iilk is that it shall not contain more than 
30,000. In ordinary market or commercial milk the numbers found 
are much higher than that, varying from about 100,000 to many 
millions. A number of cities have an official standard of 500.000 
per c. c. for ordinary milk, any milk containing a greater number 
being regarded as suspicious and subject to investigation. In the 
largest cities it would probably be necessary, at least in the summer, 
to set the standard even higher, because their milk comes from 
greater distances and is therefore older; the standard is 1,000.000 
in Chicago (in the summer) and in New York. Such a number — 
1.000,000 per c. c. — is by no means extraordinary, but with decently- 
good, fresh milk, it should not often be exceeded. When the milk 
verges toward souring or spoiling, the number of bacteria again 
takes an enormous leap up into the hundreds of millions ; but such 
milk will almost invariably bear an obvious danger-signal in its 
taste and odor. If it sours "clean" it is not likely to be so unwhole- 
some as milk of an intermediate bacterial count, having in the neigh- 
borhood of 10.000.000 per c. c. 

Unfortunately the practice of pasteurizing the milk before sell- 
ing it. as is so largely done in St. Louis, makes us less able to judge 
of its conditions from its bacterial content. The bacteria not only 
exist in the milk, but also "do things" to it ; and these changes which 
take place in the milk remain after the bacteria are killed. Conse- 

18 



quently pasteurized milk containing for example 100,000 bacteria 
per c. c. cannot be put in the same class with raw milk containing 
the same number ; for the former when it was raw. probably con- 
tained from 1,000,000 to 10.000,000 per c. c, all of whose by-prod- 
ucts are still in the milk. This consideration must be borne in mind 
in interpreting and comparing the bacterial counts of pasteurized and 
unpasteurized milk. (It is not denied in the least that, generally, 
milk of commercial grade and miscellaneous origin will be safer and 
more wholesome after pasteurization than before.) 

In our summer investigation, the numbers of bacteria were de- 
termined in all the samples of milk which we examined ; these came 
from all sorts of sources, as previously explained. In order to give 
the information about the commercial-milk samples as briefly as 
possible, they have been arranged in groups and the averages for the 
different groups are given in the table. In several of the classes 
there were one or two samples which had to be thrown out because 
there was something abnormal about them, in order to take the 
class-averages from a reasonably homogeneous group of samples. 
These excluded samples included most of those with very high 
-counts (because these were sour or verging on sourness), so that 
if all had been counted the averages would have been still higher. 
Of course the milk from some dairies was far better than the aver- 
age, and from others much worse. 

\unil)er liaviiit; 



Clai< 



No. of 
Samples 



A. Bottled milk 32 

I. From dealer 21 

a. Pasteurized ... 18 

b. Raw 3 

II. From customers 11 

a. Pasteurized ... 9 

b. Raw 2 



Av. No. 

Bacteria 

per cc. 

6,000,000 
2.800,000 
2.400,000 
5,100.000 

12,200,000 
8,300.000 

29.600.000 



13 
10 
10 

o 
3 
3 
o 



B. ''Loose" milk t,^ 

I. From dealers.... 31 



a. Pasteurized . . . 

b. Raw 

1. Shipped .... 

2. City milk . . . 
II. From customers 

a. Pasteurized .. . 

b. Raw 



33.300.000 
29,500,000 
27,400,000 
23,400,000 
43,000,000 
6.400.000 

2 

I 5.600.000 
I 1 80.000.000 



13 

17 

6 

10 



20 

19 

10 

8 



Several interesting points appear in these figures : 
( I ) The superiority of the bottled milk. Comparing the sam- 
ples obtained from the dealer, we find that the "loose" milk con- 
tained on the average lo tiiues as man\- bacteria as the bottled 
(29.500.000 — 2.800.000V Moreover all the samples with less than 

19 



one million bacteria per c. c. were among the bottled milk, while the 
majority of the very high comits came from the "loose" milk. If 
we consider only the pasteurized milk, the superiority of bottled milk- 
is equally striking, the bacteria being there in the ratio of i to ii 
(2,400,000 to 27,400,000). In the case of one dairy from which we 
had a number of samples — all pasteurized by the same machine — the 
same ratio of i to 10 was found to hold between the bottled and 
"loose" milk (1,400,000 — 14,000,000). The dititerence in such a 
case must arise from development of bacteria in the "loose" milk 
after pasteurization, unless possibly an originally poorer grade of 
milk is used for it ; on either supposition, the figures are impressive 
testimony to the sanitary superiority of the bottled milk. 

2. The increase of bacteria after the milk gets into the hands 
of the consumer. There were too few samples of "loose" milk ob- 
tained from customers to give reliable information, and the same is 
true of the raw bottled milk ; but comparing the pasteurized bottled 
milk in the two sub-classes, it appears that the samples "From cus- 
tomers," which were taken at an average period of four hours after 
delivery, contained on the average four times as many bacteria 
(8,300,000 per c. c.) as the other samples purchased directly (2,400.- 
000 per c. c). In these cases, since the milk was kept in the bottle, 
the bulk of the deterioration undoubtedly arose from allowing the 
milk to become, or to remain, too warm. As a matter of fact, eight 
out of the eleven samples were above 60 degrees when we found 
them ; at such temperature the bacteria could easily quadruple inside 
of four hours. 

3. The fact that the pasteurized bottled milk gave the lowest 
average of any group (2,400,000 per c. c). It should be remem- 
bered that this number cannot fairly be compared with the figures 
for raw milk, without bearing in mind as explained previously, that 
a given number of bacteria in pasteurized milk implies a much larger 
number of previous inhabitants. On the other hand, even this much 
of an advantage for the pasteurized milk disappears when we con- 
sider the "loose" milk, of which the pasteurized samples had actually 
a somewhat higher count than the raw ones (27,000.000 against 
23,000,000). This rather looks as though the fact that the milk 
had been heated, tempts the milk-man to be more careless with it 
than with the raw milk. 

4. The comparatively low numbers of bacteria found in the 
"city" milk — 6,400,000 per c. c. This is much lower than the aver- 
age for any other group of "loose" milk samples. All but one of 
these samples came directly from the producing dairy : and the 
smaller number should be credited to this greater freshness rather 
than to any greater cleanliness. Of course it is an advantage in any 
case. 

Taken as a whole, these figures show a decidedly poor grade of 
milk and an unsatisfactory — not to say insanitary — milk supply. 
Bearing in mind that our samples included some w^hich had been 
subject to pretty bad handling, and man>- from the class of milk 

20 



which may be well over 48 hours old when sold, this is not surpris- 
ing. In fact the two phases of the investigation, into the history of 
the milk, and into the resulting condition thereof, lead to the same 
general conclusion. Of course there are exceptions; but THERE 
IS ALTOGETHER TOO MUCH POOR AHLK. Such milk- 
even the bottled milk — is of much too high a bacterial content to be 
safe food for babies ; and one is tempted to say that most of the 
'ioose'" milk is untit for human consumption. It is possible to con- 
trol the milk-supply sufficiently to remove some of the causes of 
this condition, and to improve the situation materially, if we make 
up our minds to grapple with the ])roblem. \\'hat some other cities 
are doing to improve and guard their milk-sujiply. will be shown in 
a succeeding chapter. 



From Bull. 56, Hygienif Laboratory. 




CLEANING COWS PREPARATORY TO MILKING 



m 



CHAPTER III. 
RELATION OF MILK TO BABIES. 

The social and sanitary conditions of the home and the measures 
employed to prevent disease are very important questions, especially 
as they relate to the amount of infant morbidity and mortality in a 
community. Yet neither of these questions is of greater moment 
for this purpose than is the problem of pure milk, a good equality 
of which is a fundamental necessity. Without it, little progress 
can be made. In fact it is a measure to prevent the spread of 
disease. 

Maternal nursing as a principle should be encouraged, but when 
this is impossible, clean milk should not only be within the reach of 
all the people, and especially the poor of our cities, but they ought 
to be unable to obtain anything else but clean milk, for other condi- 
tions invite disease and death. Although the need for clean milk is 
greatest among babies, older children, nursing mothers, invalids and 
others are vitally affected by it. 

The requirements of good milk for infants are freshness, free- 
dom from bacteria, cleanliness and proper temperature. Unclean 
milk stands next to parental ignorance as the most important cause 
of sickness and death among babies. The two causes are closely 
inter-related. Mothers when they find it necessary feed cows' milk 
on their own responsibility and frequently do not know the danger 
that lurks in the milk they buy and use. The solution of the prob- 
lem requires not only education and knowledge, but pure milk. 
Without the latter, education can have but little effect. 

The few thousand quarts of certified milk used in our city are 
an insignificant portion of the daily consumption of milk, and aft'ect 
very few outside of the well-to-do classes. The general milk supply 
must be improved. The St. Louis Pure Milk Commission, a phil- 
anthropic organization, undertakes to supply many of the poor of 
this city a good quality of milk at a low price. The Commission 
hopes in this way to lessen the infant mortality of St. Louis. Thou- 
sands of dollars are accordingly contributed every year to support 
this organization. The permanent solution of the problem, how- 
ever, requires such an improvement in the general milk supply of 
the city as will make it fit food for babies. The need of such com- 
missions is a confession that the city is not doing its duty. Mean- 
while hundreds of little children are dying from the consequences 
of the use of inferior milk. 

U 



Morbidity of Children. 

In the investigation conducted by the St. Louis School of So- 
cial Economy in the summer of 1910 into the condition of bottle- 
fed babies, nine selected districts studied gave the general condition 
of 1. 941 children under five years of age in those districts. It was 
found that a very large percentage of the whole number of children 
who were bottle-fed were being given ordinary dairy milk bought 
from adjacent bake shops or groceries or from the wagons selling 
loose milk and often from wagons selling a poor grade of milk. Of 
the sick bottle-fed cases suffering from digestive troubles it was 
discovered on revisitations in September that a very large percent- 
age had died. In some districts the number was as high as 50 per 
cent of the whole number of cases so studied. And yet w^hen the 
visitor found a baby sick, if possible she referred the case at once to 
the family physician or the nearest feeding clinic. Even this, how- 
ever, was unable to counteract the evil efifects of bad milk. 

Among the poor throughout the city probably about 20 per 
cent of the babies use dairy milk or artificial food. Among the 
middle and well-to-do classes, however, the percentage of babies who 
depend on dairy milk is much larger, perhaps not more than 40 per 
cent being breast fed. Certified milk has some vogue among these 
classes, but the great majority depend on ordinary cows' milk. This 
therefore is the chief food of thousands of young children in this 
city, although it is one of the most common causes of disease. Adults 
likewise may suflr'er from certain diseases for which milk is a me- 
dium. Driven by the unwholesomeness of ordinary dairy milk a 
large number of housekeepers boil the milk in order to lessen the 
danger of disease. It is well known, however, that such milk 
therebv becomes less adaptable as food for babies and often is posi- 
tivelv harmful. Yet boiling may be the lesser of two evils. The 
healthfulness of children demands milk which is originally clean and 
which need not be subjected to such artificial processes. 

In the districts studied, which were comparatively poor sections, 
84.5 per cent of the children imder one were breast-fed; the re- 
mainder, or about one-seventh of ihe whole, were fed on cows' milk 
and artificial foods. The children over one were, of course, largely 
fed on cows' milk and ordinary table foods. This is especially im- 
portant in connection with the diseases of the digestive system which 
occur so frequently during the second year of life. 

Some of the effects of artificial feeding are apparent in the facts 
discovered among the cases canvassed in our investigation. It ap- 
pears that the 15.5 per cent bottle-fed babies furnished more than 
half of the sickness occurring during the summer months and 74 
per cent of the cases of digestive trouble. In other words these 
cases were fifteen times as numerous among bottle and artificially- 
fed infants as among those nursed directly by the[r mothers. Recent 
investigation in the tenement districts of Xew York City show the 
disproportions to be twelve to one. 

Bad milk deteriorates so rapidly in the summer inontlis. if not 
properly cared for, that diseases due to such milk are \-ery common. 

23 



Our investigations showed that last summer in the districts studied 
the digestive and nutritional diseases furnished 6i per cent of all 
sickness among infants although the proportions for the entire year 
are little more than half as large. In other words the disease rate 
for digestive and nutritional diseases is almost doubled for the sum- 
mer months. The reasons for this are very clear. Milk having a 
low bacterial count, such as "certified" or "Pure Milk Commission" 
milk is but an insignificant carrier of disease. It is the ordinary 
dairy milk, which according to our investigations contained almost 
countless bacteria, that is the chief factor in causing the digestive 
diseases. These bacteria, be it remembered, are present while the 
milk is still in the hands of the retailer — before it reaches the con- 
sumer. Whether the milk is well cared for by the consumer or not, 
the disease germs are already on hand and have rapidly multiplied 
owing to the slip-shod methods of producing and handling much of 
the dairy milk used by the citizens of St. Louis. The need of good 
milk and of intelligent care of the same by producers as well as con- 
sumers is therefore only too evident. 

Impure milk causes contagious disease. In 1900 Dr. Kober re- 
ported to the International Medical Congress that 195 epidemics of 
typhoid, 90 of scarlet fever and 36 of diphtheria occurring" in the 
L'nited States had been directly traced to the use of infected milk. 
Unless properly inspected our dairy milk supply constantly threatens 
us with disease, especially diseases of children. 

Again the total number of cows contributing to the milk supply 
which have been tested for tuberculosis and found free from disease 
is very small. St. Louis requires no test of cows either inside or 
outside the city. Where tests have been made it has been discovered 
that a very large proportion of the milch cows are afflicted with 
tuberculosis. That the disease germ is carried by milk no longer 
admits of question. It is now recognized that infection with tuber- 
culosis through the use of milk is not only possible but occurs to a 
considerable extent. Much of this occurs in early life, that is chil- 
dren are infected, but the disease may develop at a later age period. 

The National Association for the wStudy and Prevention of 
Tuberculosis, has urged the thorough inspection of dairies and 
herds and the production and handling of milk under proper sani- 
tary conditions in order to reduce the mortality from tuberculosis. 
The Association holds that not only pulmonary tuberculosis, but to 
some extent other forms of the disease may be of bovine origin. 
Accordingly the milk supply needs to be carefully guarded. 

Mortality ov Children. 

The School of Social Economy investigated the deaths of more 
than one thousand children formerly living in the east end of the 
city. Of this number 837 lived long enough to have a feeding his- 
tory. The remainder died shortly after birth. A total of t,/2 of 
the children having such a history, or 44 per cent, died of digestive 
or nutritional disorders — a somewhat higher proportion than that 
for the city as a whole. On the other hand, the high proportion 

24 



of deaths throughout tlic cUy mmiu these diseases indicates the uni- 
versal presence of coiunion causes. Chief among these causes as 
will be subsequently shown is the quality of the milk consumed. 

The relation of this mortality to the character of food con- 
sumed by the child is a striking illustration of the influence of 
various methods of feeding. As shown before the great majority 
of babies are breast-fed, but bottle-fed babies are the ones most 
subject to disease. More than one-half of the babies dying under 
one year of age were bottle-fed. Only about one-fourth of the 
children dying from the digestive diseases were being breast-fed 
at the time of death, the remainder used .cows' milk or milk substi- 
tutes. In view of this great disproportion, there can be no doubt 
of the deleterious consequences of the use of ordinary market milk. 

The breast-fed baby of the alley with its many disadvantages 
has as good a chance for life during the first nine months as the 
bottle-fed baby of the avenue using cows' milk. The question of 
food is all important and only later do the insanitary conditions of 
the slums weaken the children of the poor. 

The following table shows the total number of deaths of in- 
fants under one year and .of children under five in St. Louis for the 
years 1909 and 1910 and also the deaths from digestive and nutri- 
tional diseases : 

I OCK") Children under ("hildren under 

- - ■ one year. five years. 

Total deaths 1.723 2,500 

Deaths from digestive and nutritional 

diseases 726 832 

1910. 

Total deaths 1.707 2,471 

Deaths from digestive and nutritional 

diseases 647 766 

It appears from these facts that the last year was somewhat 
more favorable than the previous year. The figures in the above 
table show that the total deaths in 1909 of infants under one from 
the digestive and nutritional diseases constituted 42 per cent of all 
deaths among children under one ; the deaths of children under five, 
33.2 per cent of all deaths among this age group, while in 1910 the 
proportion of deaths from these causes fell to 37.8 and 30 per cent 
respectively. 

Other facts for the babies or children under one year of age 
are given in the following table : 

Deaths from Digestive and Nutritional Disease During the ^Months 
June to September (inclusive). 

Children Proportion of Deaths Proportion of Total Deaths 

under from ;ill causes for from Dig. and Nut. 

one three months Diseases for entire year 

1909 398 55-8 54-8 

1910 4Q8 52.5 61.0 

25 



It appears from this table that while the deaths from digestive 
and nutritional disorders were fewer among the babies in 1910 than 
in the previous year, the number dying during the summer months 
was exactly the same. Consequently the proportionate loss during 
the last year was greater than before. Instead of 54.8 per cent of 
the deaths occurring during these four months 61 per*cent fell 
within this period in 1910. In other words three-fifths of the 
deaths last year from two groups of diseases occurred during one- 
third part of the year, that is, the death rate was almost exactly 
three times as high during the summer months. This applies only 
to children under one. 

On the other hand, in 1909 49.4 per cent of all deaths under 
five during the four summer months were due to these two causes 
and the proportion fell in 19 10 to 49 per cent. Nearly half of all 
children dying under five during these months are victims of dis- 
eases depending to a large extent on the quality of milk and food 
consumed. 

In spite of a cooler summer, and considerable expansion of the 
work of the Pure Milk Commission, last year shows but little ad- 
vantage over the preceding one. The death rate from these two 
groups of diseases was reduced but slightly, whereas the weather 
conditions warranted a considerable reduction. When we remem- 
ber that poor milk is the largest single cause of these disorders we 
realize how important is a good milk supply. The facts also force 
us to conclude that the milk furnished the city, has undergone little 
improvement during the past year as far as its general cleanliness 
is concerned. 

The heavy mortality from the digestive diseases during the 
summer months needs explanation. It is not the direct efifect of 
the heat that is so injurious as the effect on the babies food, which 
easily spoils, and produces sickness and death. Heat does not kill 
the babies. It is cows' milk improperly handled by dealers, coupled 
with the warm weather and ignorant care of this milk by mothers 
which is in large part responsible for the digestive diseases. Good 
milk is the first step in bringing about a reform. Without it care 
in handling milk is but an idle form. 

The facts show that deaths from digestive diseases were preva- 
lent during the summer months, only among bottle-fed babies. 
Out of 237 children in the east end of the city dying during the 
four hottest months only 75 had been restricted to breast-feeding, 
while the number of breast-fed babies dying showed practically no 
change in proportion throughout the year. Although the mortality 
among babies using cows' milk is heaviest in the summer months, 
this is not true of babies who are nursed exclusively. In fact our 
figures show a slightly smaller proportion among such infants for 
the summer months. This indicates that it is not heat, but the 
quality of food consumed which largely causes the deaths from these 
diseases. Again when we recall that the great majority of babies 
are nursed directly, but that 68 per cent of the children dying from 
digestive and nutritional diseases during the summer of 1909 in 

26 



the district studied were being artificially fed. then the argument 
for good wholesome cows' milk becomes invincible. In other cities 
similar proportions exist between the fatalities among breast-fed 
and bottle-fed babies. For example, statistics taken by Dr. Goler 
of Rochester, N. Y., for the months July, August, September, 1908, 
show that out of 144 deaths under one, 84 per cent were bottle- 
fed. Accordingly there can be no question but that milk is an im- 
portant factor in causing disease. 

Experience of Other Cities. 

The experience of St. Louis' with its milk supply is being dupli- 
cated elsewhere. The New York City Department of Health in its 
annual report for 1904 gave the following reasons for a decrease 
of 62 per cent in its infant mortality from 1881 to 1903: 

a. Purer milk secured through increased official watchfulness. 

b. Pasteurization of milk by private philanthropies. 

In order to lessen its infant death rate the city has taken the 
steps discussed in the following chapter. Private philanthropy has 
also been very active in supplying good milk to needy mothers with 
small babies. 

In 1897 Rochester, N. Y., began a series of aggressive meas- 
ures in favor of a cleaner milk supply. Attempts were made to 
raise the standards of dairies and the quality of milk was consider- 
ably improved. The value of good milk was especially shown by 
the results obtained from the work of the Health Department in 
providing stations supplied with the best quality of milk. This 
milk was recommended to mothers with remarkable results. Not 
only were the annual number of deaths among children greatly re- 
duced, but the excessive death rate of the summer months was sub- 
stantially modified. The disparity between the different seasons 
of the year was greatly reduced. In 1909 Chicago began a vigor- 
ous campaign to raise the standard of its milk supply in order that 
its infant death rate might be reduced. Other cities are doing 
similar work, with corresponding reductions in their child mortality. 
Why should not St. Louis? 

.According to a careful estimate made by Prof. Irving Fisher, 
of Yale University, 60 per cent of all deaths from the diarrheal 
diseases are preventable and the mortality of all children under one 
can be reduced substantially one-half. Such proportions applied to 
St. Louis indicate that at least 500 children can be saved annually 
from death due to digestive troubles and an additional 500 from 
other causes. The saving of the first 500 depends largely upon the 
success attained in securing a milk supply, free from impurities 
and noxious bacteria. Many of the deaths from the epidemic dis- 
eases are also due to milk infected with the fatal germ. In other 
cities such cases have been traced and the source of infection has 
often been located at one of the dairy farms supplving the city. 
The total mortality chargeable to bad milk, therefore reaches amaz- 
ing proportions and we cannot remain blind to this needless suffer- 
ing and loss of life, especially when the remedy lies close at hand. 

28 



The brief facts herein presented plainly show how important 
is good wholesome food for babies. Feed ordinary dairy milk and 
the mortality jumps to enormous proportions. Feed it during the 
summer months and hundreds of babies die. Both the rates of sick- 
ness and of mortality show this baneful influence. Yet milk is not 
intrinsically bad. It is the best substitute food for children. What 
then is the difficulty? Simply this, the milk supply of St. Louis 
needs to be produced under clean conditions by clean milkmen, be 
carried to St. Louis under proper refrigeration and when retailed 
meet the required standards of coolness. When a woman once 
remarked to Dr. Osier that Providence had taken her baby he re- 
plied, Providence had nothing to do with it, it was dirty milk ; and 
the facts show that he was right. One of the most important 
methods of reducing the death rate and increasing the healthful- 
ness of the people of St. Louis is the promotion of a better and 
purer dairy milk supply. 



29 



CHAPTER IV. 
^IILK REGULATION IN OTHER CITIES. 

Tlie following" account of the milk regulation of a few Ameri- 
can cities, deals only with the sanitary provisions. Practically all 
cities, as well as a number of states, prohibit the adulteration, skim- 
ming, or watering of milk. The sanitary side of the problem, how- 
ever is more difficult ; and on these points the methods of protec- 
tion adopted in other cities give valuable suggestions, as to what 
can be done. This is especially true of the larger cities, because in 
them the situation — with the milk coming to the customer through 
one or two sets of middlemen — ^closely resembles that in St. Louis. 
The necessarv precautions for getting a wholesome supply of milk 
are essentiallv the same everywhere : — cleanliness, protection from 
contagion, cooling, and prompt delivery. But the difficult}- of en- 
forcing them varies almost directly with the size of the city. This, 
however, is only the more reason why a large city must take vigor- 
ous measures to protect itself: 

Washington, D. C. 

\\"ashington has a thorough system of dairy inspection, both 
within and without the District. The dairies in other States are 
controlled by a provision of the law, that no one "shall bring or 
send into the District of Columbia for sale any milk without a 
permit so to do from the health officer of said District," and that 
the permits shall be issued "on condition that none but pure and 
unaclulterated milk shall be . . . brought into said District ; that in the 
management of said dairy or dairy-farm said applicant shall be 
governed by the regulations of the health office of the District of 
Columbia . . . issued for dairies and dairy farms in said District . . . 
and that said dairy or dairy farm may be inspected at any time with- 
out notice b\- the health officer of the District of Columbia or his rep- 
resentative." These regulations are enforced by veterinary inspect- 
ors living in the country in the districts of which they have charge. 

This was one of the earliest provisions for inspection by a city 
of dairies located outside of its limits ; and it has worked ver}- satis- 
factorily. Practically all cities wliich have such country inspection, 
follow a similar ])lan of requiring a permit for imj^orting milk into 
the city, and of making it a condition for the granting of such a 
permit that the aj^plicant abide by the rec[uirements of the city in 

30 



question and agree to admit its inspectors ; tlien a violation of tile 
requirements is followed by a revocation of the permit and a pro- 
hibition of shipments from that source. 

W ashington also requires the tuberculin-testing of all milch 
cows in, or imported into, the District of Columbia, and the 
slaughter of all which are found to be tulierculous. 

New York. 

Milk comes to New York from many states, and through the 
hands of collecting creameries as in St. Louis, so that the New 
York Health Department has as complicated a situation to deal 
with as that of any city; and since the milk comes from greater 
distances (as far as 400 miles) than in the case of any other 
American city, it is by so much more difficult to secure a satisfac- 
tory milk supply. Though this has not been fully accomplished, still 
there are a number of excellent points about the New York system 
of inspection. Country inspectors are employed (26 in 1908). who 
inspect and report on the dairy farms as well as the creameries, 
in all the states which supply the city; where conditions are "notably 
insanitary" the company receiving that milk is notified not to ac- 
cept it for sale in the city, and the prohibition is maintained until 
the l^ad features are remedied. Especial attention is given to the 
dairy water supplies, that they shall be free from contamination ; 
also to the exclusion of milk from farms where there is unquaran- 
tined contagious disease. In the city there are an almost equal 
number of inspectors who make routine examinations of milk sold, 
and of the places where it is handled or sold. ( )ne of the commend- 
able features of the New York regulations is that all milk found 
above 50 degrees, as well as milk that is sour, is forthwith destroyed. 
Also New York has for three years had rules governing pasteuriza- 
tion, which, among other items, forbid repasteurization, and require 
that pasteurized milk be placed in sterilized and sealed containers 
and sold within 24 hours. 

There are five oiificial grades of inilk in New York ranging from 
"milk" to "certified milk," each of which is produced and sold under 
special regulations. The sanitary requirements for plain "milk'" 
are, that it shall not be taken from cows fed on unwholesome food 
(including distillery waste) nor from cows "kej^t in a crowded or 
unhealthy condition," that its temperature shall not be higher than 
50 degrees F., and that it shall not contain "an excessive number 
of bacteria." (Apparently 1,000.000 bacteria per c. c. or more, is 
considered an excessive number ; in 1908 2^ per cent of 6,000 sam- 
ples fell in that class.) In addition, it is required and enforced that 
all milk cans and bottles must be cleaned as soon as they are 
emptied. 

Chicago. 

Giicago. of all the large cities, is making the most vigorous 
attempt to safeguard its milk supply. It has an elaborate system of 

31 



regulations and inspection, protecting the milk from the time it is 
produced until it is retailed — hampered, however, by an insufficient 
number of country inspectors. There are rules for dairy farms, 
covering the health and care of the cows, the condition of the barn- 
yard, the construction and cleanliness of the stable and milk-house, 
methods of milking and of care of the milk, construction and clean- 
ing of milk utensils, water supply, and protection against contagious 
disease. The rules for milk depots (i. e. handling plants) prescribe 
in detail, freedom from contaminating surroundings, the construc- 
tion, drainage, ventilation, and cleaning of the building, the condi- 
tion and care of apparatus and utensils, the cooling of the milk, 
and the exclusion of communicable disease. Milk must not be ex- 
posed on the street or in the wagons ; if it is bottled, this must be 
done at the depot, and if it is sold in bulk, it must be carried in a 
special can from which it can be drawn without dipping. Finally, 
none but bottled milk may be sold from stores. As the head of 
the milk-inspection service says : "We have succeeded in eliminating 
the old dipper method of milk-vending in stores and on wagons.'" 

There is a bacteriological standard for milk on arrival of 500,- 
000 per c. c. in the winter and 1,000,000 in the summer; the sale of 
milk containing over 3,000,000 per c. c. is prohibited, as is also that 
of milk containing any pathogenic bacteria. 

The most prominent feature, however, of the Chicago milk 
situation, is the campaign against tuberculosis. All milk sold in 
Chicago must be either (a) from cows free from tuberculosis, as 
shown by the tuberculin test, or (b) pasteurized. The exception, 
moreover, extends only until 1914; and the pasteurization process 
is regulated and watched by the Health Department in order to 
ensure that it shall be efficient — that is, that it shall destroy 99 per 
cent of all the bacteria and all the pathogenic bacteria, in the milk. 
All continuous pasteurizing machines must be equipped with an 
automatic heat-regulator or an automatic temperature recorder. 
Pasteurized milk must be cooled to 45 degrees or less. 

Chicago is the pioneer among the large cities in taking the 
advanced stand of enforcing the tuberculin test. It is stated by the 
officer in charge that by last November, one-third of all the cows 
supplying the city had been tested. 

Boston. 

Boston's regulations provide, in addition to recjuiring a license 
for the production and sale of milk within the city, that "no milk 
which is not produced or handled in a manner satisfactory to the 
Board of Health, shall be brought into, kept, delivered, distributed, 
sold or offered for sale in said city." The city has relied upon the 
State Board of Health for farm inspection, and confined its efforts 
to conditions within the city — the methods of handling the milk, 
and its bacteriological condition, for which 500,000 per c. c. is the 
standard. Among the rules for the handling of milk are the re- 
quirements that cans and bottles be cleaned immediately upon 

32 



emptying, that only bottled milk l)e sold from stores, and that when 
milk is tested by tasting — a not uncommon practice — this shall be 
done by means of some implement (other than the hands of the 
taster) which shall not be used again until sterilized. The last 
matter, with the danger of contagion involved in careless tasting, 
is nevertheless one that is too frequently overlooked. Special at- 
tention is also given to enforcing thorough cooling. 

When a dairy farm is adversely reported upon by the State 
Board, the dealer getting the milk from that farm is held responsi- 
ble, and is notified to discontinue his purchases until conditions are 
improved. In most cases this step suffices to bring about the de- 
sired improvements ; occasionally it is found necessary to prohibit 
importation from some farm permanently. 

The following figures as to the bacteriological condition of the 
Boston milk for 1908 are of interest : 

L'luler 
No. noO.OOd Under Over 

Sauu'les. per c. c. 1,(100,00(1 1,000,000 

Milk on arrival 4-04 86.4% 92.9% 7. 1% 

Milk from wagons 1275 yi. i9f 85.29* 14.8% 

Bottled . ." ". 71 -^A ... 

Can f 17 . < )'^; 

Pasteurized milk from 
wagons — 

Bottled 47 9i.57f 93-6'/^ 6.4% 

Can 141 60.3% 83.7% 16.3% 

Milk from stores 281 43-47' 69.7% 30.3% 

These last figures, which were ol^tained before the ])rohibition 
of the sale of can-milk in stores, confirm our finding in St. Louis 
that such milk is the worst of all grades of milk. The most striking 
feature of the Boston data is the fact of the existence of a consider- 
able proportion of pasteurized milk, especially when not bottled, 
which contains very large numbers of bacteria. In fact, as in St. 
Louis, the "loose" pasteurized milk averages worse than the "loose" 
raw milk. It is also mentioned by the inspector tliat two firms 
whose raw milk on arrival showed the highest percentage of high 
count samples, are engaged in pasteurizing. This seems to indi- 
cate that milk which is pasteurized is apt to have been in worse 
condition before pasteurization, than the general average of the 
milk. 

San Franci-sco. 

San Francisco regulates its milk business under the permi*" 
system, essentially as in Washington, permits being required not 
only to produce or sell milk within the city, but also to "ship, send 
or bring" milk into the city. The applicant must satisfy the Board 
of Health that "the production, trarsportation, storage and handling 
of the milk is to be under sanitary conditions." "Permits shall 
be subject at all times to revocation by said Board of Health in its 

34 



discretion upon sufficient cause therefor shown," after a hearing ; 
any refusal of any licensee to allow ofificial inspection is specifically 
made a cause for revocation. San Francisco oflfers one original 
suggestion in the provision that when a permit has been revoked, 
no further permit shall be granted to the same person until he 
shall file with the Board of Health a bond for $500 for the faithful 
observance of the regulations of the law and of the Board. 



3d 



RECOMMENDATK )NS. 

I. That a system of permits for all branches of the milk busi- 
ness be established, and especially that a permit be recjuired to ship 
milk into the citv. 

II. That it be made a condition of the granting of all per- 
mits that the holders sign an agreement to comply with all the 
requirements of the ordinances, and of the Board of Health, and 
especially that all producers outside of the city who wish to ship 
milk into the city agree to produce and handle their milk in accord- 
ance with the rules of the Board of Health and to admit the Health 
Department inspectors ; or if the shipper be not the producer that 
he agree to buy milk only from those who produce it under the 
above conditions. 

III. That permits may be revoked by the Board of Health, 
after a hearing, for any violation of the agreement made by the 
holder. 

I\ . That wlien a ])ermit has been revoked, the same person 
(firm or corporation) cannot obtain a new one unless he gives $500 
bond for the faithful performance of his agreements. 

V. That the prohibition of adulteration, skimming, and water- 
ing be left in charge of the City Chemist, as at present. l)ut with 
an additional ins])ector. 

\ I. That the Board of Health be given authority to make all 
necessary detailed sanitary rules for all branches of the milk busi- 
ness ; that the enforcement of the sanitary regulations be ])laced in 
charge of the Sanitary Division, and tliat in addition to the four 
city dairy inspectors at present employed. ]:»rovision lie made for 
eight countrv inspectors. 

\ II. That the existing requirements that milk ])e ke|)t below 
50 degrees F. be maintained, and reinforced l)\ a provision for the 
confiscation and destruction of all milk found al)ove 51) degrees. 

VIII. That pasteurization be regulated so as to secure better 
results, and that double ]iasteurization be prohibited. 

Xo recommendation is here made as to the elimination of tuber- 
culous dairy-cattle, not because the subject lacks importance, but 
because it is so difficult that it seems better to take it up separately. 



36 



LIBRARY OF CONGRESS 



000 896 088 4 



